Gastroenterology · Oncology · 3 h ago
Advanced Neoplasia Rates Similar After Early- and Average-Onset Colorectal Cancer
A retrospective cohort study compared postoperative metachronous advanced neoplasia in 230 patients with early-onset and 504 with average-onset colorectal cancer. Rates were similar, and the findings did not support an age-specific surveillance strategy based on early-onset status alone.
- MAN rates were 13% in EOCRC and 16.1% in AOCRC.
- The difference in rates was not statistically significant.
- Smoking, older age, and distal index cancer were associated with MAN.
Postoperative colorectal cancer surveillance intervals are largely based on evidence from patients diagnosed at age 50 or older. This retrospective cohort study compared surveillance findings in patients with early-onset colorectal cancer (EOCRC; younger than 50) and average-onset colorectal cancer (AOCRC; 50 or older). It included 230 patients with EOCRC and 504 with AOCRC who had at least one postoperative surveillance lower endoscopy between 2011 and 2021; patients with inflammatory bowel disease or hereditary colorectal cancer syndromes were excluded.
Metachronous advanced neoplasia (MAN) was detected in 13% of the EOCRC group and 16.1% of the AOCRC group, a difference that was not statistically significant (p=0.342). AOCRC patients had lower MAN-free survival. Nonadvanced neoplasia was less often the most advanced finding in EOCRC patients (17% vs 26%; p=0.009). Older age, smoking exposure, and a distally located index cancer were independently associated with MAN.
The investigators concluded that the study did not show a sufficiently increased MAN burden in EOCRC to support a separate surveillance strategy based on age at diagnosis. The findings are observational and apply to patients who underwent postoperative endoscopy; they do not establish optimal surveillance intervals. Smoking was associated with MAN, but the study does not establish a causal effect.
In practice
For patients with sporadic colorectal cancer who undergo postoperative endoscopic surveillance, this cohort found no statistically significant difference in metachronous advanced neoplasia rates between those diagnosed before age 50 and those diagnosed at 50 or older. The results do not support changing surveillance intervals solely because a patient had early-onset disease, but they do not define optimal intervals or prove equivalence. The retrospective cohort included only patients who had at least one surveillance endoscopy, and smoking exposure was associated with MAN without establishing causation.
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The American Journal of Gastroenterology: Metachronous Advanced Neoplasia in Early Onset Colorectal Cancer ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.